Study Outlines Components of Remote Diabetic Retinopathy Screening Success

View of retina showing severity 4 of diabetic retinopathy, associated with diabetes mellitus. Florid neovascularization, large patches of yellow exudate and severe hemorrhages are all present.
Telemedicine programs need to close the “communication gap” between screening and diagnosis in diabetic eye disease.

In a Philadelphia-based telemedicine screening program, only 9.5% of patients who received a “referral-warranted” notice due to potential diabetic retinopathy actually obtained another eye exam, showing how merely identifying cases that require follow-up is “not enough,” according to the study, published in BMC Ophthalmology

“A successful telemedicine screening program must close the communication gap between screening and diagnosis by a reviewer to provide timely follow-up by eye care specialists,” according to investigators.

The study, a retrospective review, looked at 15 months of data from March 2016 to May 2017 of 689 digital retinal screening exams on 1377 eyes of patients with diabetes in Temple University Hospital’s primary care clinic. The diabetic telemedicine project was designed to help those who need cost-effective access to the right retina care for close monitoring/treatment.

Researchers found that the majority of photographs were read to have no retinopathy (755, 54.8%), while others (449, 32.6%) couldn’t be interpreted by the study clinician. Approximately 52% triggered a request for referral to ophthalmology. Referrals should have been requested for diabetic retinopathy discovered in one or both eyes, inability to assess the presence of retinopathy in one or both eyes, or suspicion of a different ophthalmic diagnosis.

About 10% (67) of patients were suspected to have another ophthalmic condition from other findings in the retinal photographs.

Among the 34 patients who successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of diabetic retinopathy detected by the screenings and what clinicians found, the study explains.

But when it came to connecting patients with the appropriate follow-up, less than 10% of referred patients completed an eye exam appointment. 

“Perhaps there needs to be more of an effort by the screening program to reach out to these patients and possibly even establishing a designated telemedicine coordinator,” the study speculates. “Alternatively, there just may not be adequate public awareness of diabetic retinopathy in our patient population. Literature pamphlets of diabetic retinopathy depicting diabetic damage to the retina may highlight the importance of screening. Training nurses to appropriately educate patients how uncontrolled diabetes can lead to permanent vision impairment is critical.”

One of the limitations of the study was its inability for appointments to be created from referrals, which dulls the effectiveness of any telemedicine screening program.


Benjamin JE, Sun J, Cohen D, et al. A 15 month experience with a primary care-based telemedicine screening program for diabetic retinopathy. BMC Ophthalmol. Published online February 4, 2021. doi:10.1186/s12886-021-01828-3.